Public drug use in eight U.S. cities: Health risks and other factors associated with place of drug use.

BACKGROUND: Drug overdose is the leading cause of accidental death in the United States (U.S.). Previous studies have found that place of drug use is associated with risks including overdose, sharing of drug use equipment, and arrest, but the research on this subject in the U.S. is limited. METHODS: Our study describes the relationship between place of drug use and health outcomes through the analysis of associations between frequent public drug use and drug-related arrest, overdose, and reuse of injection equipment. We analysed data from a cross-sectional, observational study of individuals who utilize syringe exchange services in 8 U.S. cities. Using regression analysis, we assessed associations between public drug use, demographic characteristics, and health risks. RESULTS: Half (48%) of the respondents (N = 575) reported that at least one of their top two most frequent places of drug use is a public place. Street homelessness (AOR = 17.44), unstable housing (AOR = 3.43) and being under age 30 (AOR = 1.85) were independently associated with increased odds of frequent public drug use. Frequent public drug use was associated with increased odds of past-year arrest for drug-related offenses (AOR = 1.87). CONCLUSION: Public drug use is associated with negative health and social outcomes. Increased access to harm reduction services, housing, and supervised consumption sites (SCS) interventions and a shift away from punitive approaches to drug use may reduce the some of the harms associated with public drug use.

Provision of naloxone to injection drug users as an overdose prevention strategy: early evidence from a pilot study in New York City.

INTRODUCTION: Naloxone, an opiate antagonist that can avert opiate overdose morality, has long been prescribed to drug users in Europe and in a few US cities. However, there has been little documented evidence of naloxone distribution programs and their feasibility in the peer reviewed literature in the US. METHODS: A pilot overdose prevention and reversal program was implemented in a New York City syringe exchange program. We assessed demographics, drug use, and overdose history, experience, and behavior at baseline, when participants returned for prescription refills, and 3 months after baseline assessment. RESULTS: 25 participants were recruited. 22 (88%) participants were successfully followed-up in the first 3 months; of these, 11 (50%) participants reported witnessing a total of 26 overdoses during the follow-up period. Among 17 most-recent overdoses witnessed, naloxone was administered 10 times; all persons who had naloxone administered lived. DISCUSSION: Naloxone administration by injection drug users is feasible as part of a comprehensive overdose prevention strategy and may be a practicable way to reduce overdose deaths on a larger scale.